Sometimes an extended stay in a hospital is necessary, but long-term hospitalization can contribute to a decline in function and an increase in disability. Rehabilitation services are important for improving patient outcomes, yet they’re often not available in developing countries.

Duke Doctor of Physical Therapy student Kira Battle wants to change this, starting by learning more about the current situation. “Understanding the availability and accessibility of rehabilitation services is an important part of health systems strengthening efforts,” she says.

Under the Doctor of Physical Therapy Division and as a member of the 2016-17 Bass Connections project team Global Alliance on Disability and Health Innovation (GANDHI), Battle led a literature review that identified only 23 studies on rehabilitation in acute care in low- and middle-income countries.

As part of DGNN’s effort to integrate physical rehabilitation into its mission, we have partnered with the Physical Therapy Department of Mulago National Referral Hospital in Kampala, Uganda to conduct research that promotes early mobilization of patients with traumatic brain injury in the acute care setting.

Not only does early mobilization allow us to begin addressing patient needs near the beginning of the care continuum, but it has been shown to improve functional outcomes in this population.

Our first step is taking a multifaceted approach to understanding baseline practice at the Neurosurgical Ward of the Mulago National Referral Hospital.

First, we are utilizing behavioral mapping to systematically track physical activity patterns of patients. This data will measure the amount, location, time and type of physical activity undertaken by the patient, as well the persons present at bedside with the patient throughout the day. At the same time, this data will quantify the effect of severity of condition and length of ward stay on physical activity levels and intensity. Describing these patterns will contribute to an initial assessment of current physical behavior over space and time.

Secondly, we are incorporating interviews with healthcare staff in the ward to evaluate perceptions of physical activity in critically-ill patients, which will highlight opportunities for education and facilitation of early mobilization.

Finally, while completing this study, we are also spending time alongside physical therapists in the ward to observe and participate in treatment sessions. This one-on-one time provides critical lessons on current daily practice and will promote vital relationships for in-country collaboration.

Once knowledge on current practice is established, our next steps are to develop and test interventions that will assist in the implementation of early mobilization in the ward. Ultimately, our long-term goal is to use these efforts as a foundation in partnership to address patients’ rehabilitative needs across the care continuum.